Bagrodia Aditya, Grover Sonal, Srivastava Abhishek, Gupta Amit, Bolenz Christian, Sagalowsky Arthur I, Lotan Yair
Department of Urology, UT Southwestern Medical Center at Dallas, Dallas, TX 75390-9110, USA.
BJU Int. 2009 Aug;104(3):326-30. doi: 10.1111/j.1464-410X.2009.08358.x. Epub 2009 Feb 11.
To evaluate the effect of body mass index (BMI, kg/m(2)) on the cost and clinical variables after radical cystectomy (RC), as studies show that obesity might adversely affect the outcomes after RC.
The charts of patients who had RC from January 2004 to March 2007 were reviewed retrospectively. Complete cost and clinical information was available for 99 patients; the patient and tumour characteristics and peri-operative outcomes were recorded. Detailed cost information (room and board, laboratory, pharmacy, radiology, operating room, surgical supply, anaesthesia, and recovery room) was obtained from hospital billing. Patients were stratified and compared in three groups of BMI, i.e. normal weight (<25), overweight (25-<30) and obese (> or =30).
The mean age of the patients was 66 years; 27% were normal weight, 38% were overweight and 34% were obese. Of obese patients, 24% had an Eastern Cooperative Oncology Group performance score of 0, vs none and 2.6% in the normal and overweight groups, respectively (P = 0.001). Those of normal weight had the highest overall and major complication rates (P = 0.57 and 0.28, respectively). Obese patients had insignificantly higher transfusion rates (P = 0.28). The direct cost was higher in normal weight ($14,314) than overweight ($13,808) and obese ($13,666) patients (P = 0.47). Higher room and board cost in normal-weight patients was the only significant cost difference (P = 0.008).
BMI was not associated with increased costs of cystectomy. The absence of differences in cost-related and clinical outcomes might be attributable to variable comorbidity among groups and the experience of a high-volume surgeon and staff at a tertiary-care referral centre that routinely cares for obese patients.
评估体重指数（BMI，kg/m²）对根治性膀胱切除术（RC）后费用及临床变量的影响，因为研究表明肥胖可能对RC后的结局产生不利影响。
回顾性分析2004年1月至2007年3月期间接受RC治疗的患者病历。99例患者有完整的费用及临床信息；记录患者及肿瘤特征和围手术期结局。从医院账单获取详细费用信息（食宿、实验室、药房、放射科、手术室、手术耗材、麻醉及恢复室）。患者按BMI分为三组进行分层比较，即正常体重（<25）、超重（25 - <30）和肥胖（≥30）。
患者的平均年龄为66岁；27%为正常体重，38%为超重，34%为肥胖。肥胖患者中，24%的东部肿瘤协作组体能状态评分为0，而正常体重组和超重组分别为0和2.6%（P = 0.001）。正常体重患者的总体并发症和主要并发症发生率最高（分别为P = 0.57和0.28）。肥胖患者的输血率略高（P = 0.28）。正常体重患者（14314美元）的直接费用高于超重患者（13808美元）和肥胖患者（13666美元）（P = 0.47）。正常体重患者较高的食宿费用是唯一显著的费用差异（P = 0.008）。
BMI与膀胱切除术费用增加无关。费用相关及临床结局无差异可能归因于各组合并症不同，以及三级医疗转诊中心经验丰富的高年资外科医生和工作人员，该中心经常诊治肥胖患者。
